The authors examined associations between smoking and alcohol consumption and the long-term incidence of age-related maculopathy (ARM) in people in the Beaver Dam Eye Study who were aged 43-86 years (n = 3,684) in 1988-1990 and examined over a 10-year period. ARM status was determined by grading stereoscopic color fundus photographs. After controlling for age, sex, and other factors, the authors found that people who had smoked more were more likely to develop large (> or =250 micro m in diameter) soft drusen (risk ratio (RR) per 10 pack-years smoked = 1.08, 95% confidence interval (CI): 1.02, 1.14) and pigmentary abnormalities (RR = 1.09, 95% CI: 1.04, 1.14) and to have progression of early ARM (RR = 1.05, 95% CI: 1.00, 1.10) than people who had smoked less. Smoking was not associated with the incidence of late ARM. People who reported being heavy drinkers at baseline were more likely to develop late ARM (RR = 6.94, 95% CI: 1.85, 26.1) than people who reported never having been heavy drinkers. Smoking appears to have a modest, positive association with early but not late signs of ARM, and heavy drinking appears to be related to an increased risk of late ARM, although the exposure and outcome were infrequent, and the effect is based on few exposed cases.